A Primer on Quality Assurance and Performance Improvement for Interprofessional Chronic Kidney Disease Care: A Path to Joint Commission Certification.

Interprofessional care for chronic kidney disease facilitates the delivery of high quality, comprehensive care to a complex, at-risk population. Interprofessional care is resource intensive and requires a value proposition. Joint Commission certification is a voluntary process that improves patient outcomes, provides external validity to hospital administration and enhances visibility to patients and referring providers. This is a single-center, retrospective study describing quality assurance and performance improvement in chronic kidney disease, Joint Commission certification and quality outcomes. A total of 440 patients were included in the analysis. Thirteen quality indicators consisting of clinical and process of care indicators were developed and measured for a period of two years from 2009-2017. Significant improvements or at least persistently high performance were noted for key quality indicators such as blood pressure control (85%), estimation of cardiovascular risk (100%), measurement of hemoglobin A1c (98%), vaccination (93%), referrals for vascular access and transplantation (100%), placement of permanent dialysis access (61%), discussion of advanced directives (94%), online patient education (71%) and completion of office visit documentation (100%). High patient satisfaction scores (94-96%) are consistent with excellent quality of care provided

Optimization of inpatient hemodialysis scheduling considering efficiency and treatment delays to minimize length of stay

Inpatient dialysis units face an uncertain daily demand of hemodialysis procedures for end-stage renal disease (ESRD) patients hospitalized for health conditions that may or may not be directly related to their renal disease. While hospitalized, these patients must receive hemodialysis in addition to any medical services needed for their primary diagnosis. As a result, when demand for inpatient dialysis is high, treatments and procedures required by these inpatients may be delayed increasing their length of stays (LOS). This research presents an optimization approach for daily scheduling of inpatient hemodialysis to maximize the efficiency of the dialysis unit while minimizing delays of other scheduled procedures that could extend the LOS of the inpatients. The optimization approach takes into account the dialysis protocols prescribed by a treating nephrologist for each dialysis patient, the variable duration of the dialysis treatments, the limited capacity of the dialysis equipment and personnel, as well as the isolation requirements used to mitigate the spread of healthcare-associated infections (HAI). In addition, a variant of the optimization approach is developed that considers uncertainty associated with rescheduling procedures that are delayed and the expected impact on LOS. An experimental performance evaluation illustrates the capability and effectiveness of the proposed scheduling methodologies. The results of this research indicate that the optimization-based scheduling approaches developed in this study could be used on a daily basis by an inpatient dialysis unit to create efficient dialysis schedules

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1092/thumbnail.jp

Analysis of Implementation Standards of Sharia Minimum Services in the Hospital: Case Study at Sari Asih Sangiang Hospital 2018

The development of sharia-based hospitals in Indonesia began with the Indonesian Islamic Health Effort Assembly (MUKISI) in collaboration with the National Sharia Council of the Indonesian Ulema Council (DSN-MUI) with the issuance of fatwa No. 107 / DSN-MUI / X / 2016 concerning Guidelines for Implementing Hospitals Based on Sharia Principles. One of them is Sari Asih Sangiang Hospital (RSSA) in the city of Tangerang, which has received sharia certification since 2018. Sharia hospitals guideline regulates Sharia Minimal Service Standards (SPM). The SPM contains regulations of reciting basmalah before procedures, hijab for patients and breastfeeding mother, mandatory training for patient's fiqh, Islamic education, gender-based ECG usage, using of hijab in the operating room, and scheduling elective surgery which not constrained by prayer times. This study uses a qualitative approach through report document review on the implementation of sharia quality indicators. The indicator format is determined by checklist, survey, medical record document; daily, monthly, and annual census recapitulation; secondary data from previous research, related literature, and in-depth interviews with correspondent criteria who responsible for implementing Sharia Quality at Sari Asih Sangiang Hospital. The results show that Sari Asih Sangiang Hospital has implemented Sharia SPM optimally, whose implementation refers to the standards and guidelines for the implementation of sharia hospitals issued by the DSN-MUI but is still constrained with the data recording problem. We suggest to put forward the need for coaching and training in Human Resources, and data recording should be done more regularly in order to maximize achievement targets

Understanding safety-critical interactions with a home medical device through Distributed Cognition

As healthcare shifts from the hospital to the home, it is becoming increasingly important to understand how patients interact with home medical devices, to inform the safe and patient-friendly design of these devices. Distributed Cognition (DCog) has been a useful theoretical framework for understanding situated interactions in the healthcare domain. However, it has not previously been applied to study interactions with home medical devices. In this study, DCog was applied to understand renal patients’ interactions with Home Hemodialysis Technology (HHT), as an example of a home medical device. Data was gathered through ethnographic observations and interviews with 19 renal patients and interviews with seven professionals. Data was analyzed through the principles summarized in the Distributed Cognition for Teamwork methodology. In this paper we focus on the analysis of system activities, information flows, social structures, physical layouts, and artefacts. By explicitly considering different ways in which cognitive processes are distributed, the DCog approach helped to understand patients’ interaction strategies, and pointed to design opportunities that could improve patients’ experiences of using HHT. The findings highlight the need to design HHT taking into consideration likely scenarios of use in the home and of the broader home context. A setting such as home hemodialysis has the characteristics of a complex and safety-critical socio-technical system, and a DCog approach effectively helps to understand how safety is achieved or compromised in such a system

Focal Spot, Winter 1973

https://digitalcommons.wustl.edu/focal_spot_archives/1007/thumbnail.jp

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

Background: This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods: An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results: Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions: The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients

The Emotional Experience of American Indians Receiving Hemodialysis and How It Relates to Treatment Adherence

This study used a phenomenological approach as an attempt to capture the essence of the experience of American Indians with diabetes who are receiving dialysis. The purpose of this study and this approach was to develop an understanding of factors that influence treatment adherence, specifically with mental health concerns. As an additional component of this study, this research also followed an advocacy/participatory approach (Creswell, 2007) in which steps to reform services are provided to the Indian Health Service in support of this marginalized group through a written Agenda for Change. Participants for this study were recruited from multiple states serving American Indians through the Indian Health Service. These sites were specifically located within the states of Oklahoma, Kansas, Iowa, Nebraska and South Dakota. Fliers were posted at dialysis clinics, post offices, general stores and community centers in which there where high American Indian populations. Participants initiated contact and were screened for meeting criteria to participate in the study. After three months with fliers posted in multiple locations, the recruitment concluded with six participants (three women and three men). The experience described by the participants was utilized to recommend a change in processes for dialysis patients in an effort to assist with acceptance for individuals and families as they adjust to the lifetime commitment and changes required by dialysis treatments. Advisor: Michael J. Schee